Subcutaneous phaeohyphomycosis of the face presenting as rhinoentomophthoramycosis

Abstract

Subcutaneous phaeohyphomycosis is the most common variety of phaeohyphomycosis and presents as asymptomatic or mildly painful, localized cysts, abscesses, or sometimes chromoblastomycosis-like lesions over the feet, legs, or hands in about 60-85% of cases. It usually afflicts adults with some degree of immunosuppression. We report a 30-year-old man, who presented with features of recurrent sinusitis (episodes of fever, nasal stuffiness, paranasal sinus pain, and tenderness), mucosal hypertrophy of the maxillary sinuses, and mid-face swelling that was freely mobile and suggestive of rhinoentomophthoramycosis. He had no other associated illness. Histology suggested tumid lupus erythematosus. The diagnosis was based on Fonsecaea pedrosoi cultured from a biopsy specimen. Combination therapy with itraconazole and saturated solution of potassium iodide (SSKI) was more effective than itraconazole used alone.